CMS Formulary

Displaying 168221-168230 of 1611142 results.
ID: 168221
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1790892
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 168222
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1790886
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 168223
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1790890
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 168224
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 2384465
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 5
Qty Limit Days: 28
ID: 168225
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1670324
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168226
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1670322
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168227
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1737789
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168228
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 309952
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168229
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 197622
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168230
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 309955
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0